感染管理と患者の安全：直前対策パック

公式集、全トピックの解法の要点、6 問の演習問題。完全な解答は巻末にあります。

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1公式と解法

感染管理と患者の安全

解き方

  1. すべての患者に標準予防策から始めます：手指衛生、予想される曝露に応じた個人防護具（PPE）、安全な鋭利器材の扱い。
  2. 経路に応じて予防策を追加します：接触（ガウン、手袋）、飛沫（サージカルマスク）、空気（N95、陰圧室）。
  3. 滅菌物は滅菌のまま保ちます：疑わしければ滅菌ではありません。拭かずに交換します。
  4. 環境内の害を防ぎます：転倒対策、身体拘束は最後の手段、火災には RACE と PASS。
  5. 与薬の権利、2つの識別子、ハイリスク薬の追加の安全対策を確認し、エラーやヒヤリハットを報告します。

2演習問題

1.感染管理と患者の安全ふつう

After teaching a patient about a new medication, how does the nurse best check understanding?

  1. AAsk the family whether they understood the teaching
  2. BAsk “Do you understand?” and accept a yes
  3. CAsk the patient to explain in their own words how and when to take it
  4. DGive a printed leaflet about the drug and assume the patient will read it at home
2.感染管理と患者の安全むずかしい

A patient is on contact precautions. Which task is appropriate for the nurse to delegate to assistive personnel?

  1. AHelping the patient bathe while wearing a gown and gloves
  2. BAssessing the wound for new signs of infection during the bath
  3. CDeciding when the precautions can be stopped
  4. DTeaching the family how to follow the precautions
3.基礎看護学ふつう

When should blood cultures be taken in a patient with suspected sepsis?

  1. AOnly after three days of antibiotics, to see if they are working
  2. BAfter the patient has recovered from the infection
  3. CBefore antibiotics are given, as long as this does not delay them
  4. DOnly if the temperature rises above 40 °C
4.基礎看護学むずかしい

A toddler is brought in with bruises on both cheeks and the parent's explanation does not fit the injuries. What should the nurse do?

  1. AConfront the parent and ask them directly whether they hurt the child
  2. BIgnore it, as children often bruise themselves
  3. CSend the child home and phone the family next week
  4. DDocument accurately and follow the child safeguarding procedure
5.微生物学ふつう

新しい感染で最初に上昇する抗体のクラスは？

  1. AIgM
  2. BIgE
  3. CIgA
  4. DIgG
6.微生物学むずかしい

第 1 期梅毒は典型的にどのような症状で現れますか？

  1. A手のひらと足の裏に及ぶ広範な発疹
  2. B心臓と脳の障害
  3. C感染部位の痛みのない潰瘍（下疳）
  4. D性器または口にできる、小さな水疱が集まった痛みのある病変

3溶液

1.感染管理と患者の安全

答え: C · Ask the patient to explain in their own words how and when to take it

これが答えになる理由

With teach-back, the patient explains the information in their own words, which shows whether the teaching worked. A yes to “Do you understand?” does not confirm understanding.

答え

C · Ask the patient to explain in their own words how and when to take it
2.感染管理と患者の安全

答え: A · Helping the patient bathe while wearing a gown and gloves

これが答えになる理由

Assistive personnel can carry out routine care for a stable patient, using the correct PPE. Assessment, teaching and clinical judgement, such as deciding when to stop precautions, cannot be delegated to them.

答え

A · Helping the patient bathe while wearing a gown and gloves
3.基礎看護学

答え: C · Before antibiotics are given, as long as this does not delay them

これが答えになる理由

Taking cultures first gives the best chance of identifying the organism. They are collected with strict asepsis, but antibiotics must not be delayed in sepsis.

答え

C · Before antibiotics are given, as long as this does not delay them
4.基礎看護学

答え: D · Document accurately and follow the child safeguarding procedure

これが答えになる理由

Injuries that do not match the explanation are a warning sign. The nurse records facts, not opinions, and refers through safeguarding procedures without confronting the family.

答え

D · Document accurately and follow the child safeguarding procedure
5.微生物学

答え: A · IgM

これが答えになる理由

一次応答では IgM が最初に現れ、続いて IgG が出て長期的な防御を担います。そのため IgM 陽性は最近の感染を示唆します。

答え

A · IgM
6.微生物学

答え: C · 感染部位の痛みのない潰瘍（下疳）

これが答えになる理由

Treponema pallidum は第 1 期に痛みのない下疳を起こします。第 2 期には発疹と全身症状が現れ、第 3 期梅毒は心臓と神経系を傷つけることがあります。痛みのある水疱はヘルペスを示唆します。

答え

C · 感染部位の痛みのない潰瘍（下疳）

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